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Transcript of Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow...
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Do fast foods cause asthma, rhinoconjunctivitis and eczema?
Philippa Ellwood
Senior Research Fellow
Department of Paediatrics: Child and Youth Health,
The University of Auckland
http://www.globalasthmanetwork.org
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Global findings from the International Study of Asthma and Allergies in Childhood
(ISAAC) Phase Three
Ellwood P, Asher MI, García-Marcos L, Williams H, Keil U, Robertson C, Nagel G and the ISAAC Phase Three Study Group. Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Thorax 2013; 68(4):351-360.
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© ISAAC 2012
http://isaac.auckland.ac.nz
1991-2012
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Thanks to
Children
Parents
School staff
Funders
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● The Asthma and Respiratory Foundation of NZ● The Auckland Medical Research Foundation● The Health Research Council of NZ● The National Child Health Research Foundation● The Hawke's Bay Medical Research Foundation● The Waikato Medical Research Foundation● Glaxo Wellcome NZ, and International Medical Affairs● Astra NZ● Maurice & Phyllis Paykel Trust● BUPA Foundation● NZ Lotteries Commission● The University of Auckland
Funders of The ISAAC Programme inNew Zealand
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© ISAAC 2012
ISAAC Network : 306 research centres in 105 countries
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© ISAAC 2012
ISAAC studied three diseases
http://isaac.auckland.ac.nz
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Asthma
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Rhinoconjunctivitis
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Eczema
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Number of Centres and Countries
ISAAC Phase Three Field work 2001 - 2003
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Number of Centres and Countries
Adolescent group – 233 centres from 97 countries
ISAAC Phase Three
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Number of Centres and Countries
Adolescent group – 233 centres from 97 countries
Childrens group – 144 centres from 61 countries
Asher MI et al. Eur Resp J 1995; 8: 483-91Ellwood P et al. Int J Tub Lung Dis 2005; 9: 10-16
ISAAC Phase Three
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• 13–14 year old adolescents and (optional) 6–7 year old children
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
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• 13–14 year old adolescents and (optional) 6–7 year old children
• Standardised core written questionnaires
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 16: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/16.jpg)
• 13–14 year old adolescents and (optional) 6–7 year old children
• Standardised core written questionnaires
• A video with clinical signs and symptoms for the adolescents
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 17: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/17.jpg)
• 13–14 year old adolescents and (optional) 6–7 year old children
• Standardised core written questionnaires
• A video with clinical symptoms and signs for the adolescents
• An optional environmental questionnaire
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 18: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/18.jpg)
• 13–14 year old adolescents and (optional) 6–7 year old children
• Standardised core written questionnaires
• A video with clinical symptoms and signs for the adolescents
• An optional environmental questionnaire
• Questionnaires were self-completed by adolescents and by parents of the children
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 19: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/19.jpg)
• Randomly selected schools from a defined area
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 20: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/20.jpg)
• Randomly selected schools from a defined area
• 3000 of each age group
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 21: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/21.jpg)
• Randomly selected schools from a defined area
• 3000 of each age group
• Centres followed written guidelines for fieldworkers
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 22: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/22.jpg)
• Randomly selected schools from a defined area
• 3000 of each age group
• Centres followed written guidelines for fieldworkers
• Questionnaires translated 53 languages & back translated
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 23: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/23.jpg)
• Randomly selected schools from a defined area
• 3000 of each age group
• Centres followed written guidelines for fieldworkers
• Questionnaires translated 53 languages & back translated
• Ethical approval obtained by each centre
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 24: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/24.jpg)
• Randomly selected schools from a defined area
• 3000 of each age group
• Centres followed written guidelines for fieldworkers
• Questionnaires translated 53 languages & back translated
• Ethical approval obtained by each centre
• Centres found their own funding
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 25: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/25.jpg)
Detailed methodology (centre report) and data checks
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 26: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/26.jpg)
Detailed methodology (centre report) and data checks
Adherence to the ISAAC protocol was assessed and centres with following response rates were excluded:
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 27: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/27.jpg)
Detailed methodology (centre report) and data checks
Adherence to the ISAAC protocol was assessed and centres with following response rates were excluded:
<70% for the adolescent group
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 28: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/28.jpg)
Detailed methodology (centre report) and data checks
Adherence to the ISAAC protocol was assessed and centres with following response rates were excluded:
<70% for the adolescent group
<60% for the children
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 29: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/29.jpg)
Detailed methodology (centre report) and data checks
Adherence to the ISAAC protocol was assessed and centres with following response rates were excluded:
<70% for the adolescent group
<60% for the children
<1000 participants for both age groups
Phase Three Methods
ISAAC multicentre, multicountry, cross-sectional study
![Page 30: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/30.jpg)
Auckland
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Auckland
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Beijing
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Guangzhou
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HongKong
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Hungary
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Jaipur
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Sweden
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Samoa
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Tokelau
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Core questionnaires - wheeze
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Current symptoms of wheeze: ‘Have you (has your child) had wheezing or whistling in the chest in the past 12 months?’
Core questionnaires - wheeze
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Current symptoms of wheeze: ‘Have you (has your child) had wheezing or whistling in the chest in the past 12 months?’
Severe wheeze symptoms: Defined as participants who in the past 12 months had ≥4 attacks of wheeze, or ≥1 night per week sleep disturbance from wheeze, or wheeze affecting speech
Core questionnaires - wheeze
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Current symptoms of wheeze: ‘Have you (has your child) had wheezing or whistling in the chest in the past 12 months?’
Severe wheeze symptoms: Defined as participants who in the past 12 months had ≥4 attacks of wheeze, or ≥1 night per week sleep disturbance from wheeze, or wheeze affecting speech
For adolescents (video):‘Has your breathing ever been like this in the past 12 months?’ was defined as ‘current wheeze (VQ)’
Core questionnaires - wheeze
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Core questionnaires – rhinoconjunctivitis
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Current symptoms of rhinoconjunctivitis : ‘In the past 12 months ‘have you (has your child) had a problem with sneezing or a runny or blocked nose when you (he/she) DID NOT have a cold or flu?’ and ‘In the past 12 months, has this nose problem been accompanied by itchy watery eyes?’
Core questionnaires – rhinoconjunctivitis
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Current symptoms of rhinoconjunctivitis : ‘In the past 12 months ‘have you (has your child) had a problem with sneezing or a runny or blocked nose when you (he/She) DID NOT have a cold or flu?’ and ‘In the past 12 months, has this nose problem been accompanied by itchy watery eyes?’
Severe symptoms of rhinoconjunctivitis: Defined as participants who, in the past 12 months, had itchy watery eyes and who answered ‘a lot’ to their nose problems interfering with their daily activities
Core questionnaires – rhinoconjunctivitis
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Core questionnaires – eczema
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Current symptoms of eczema: ‘Have you (has your child) had this itchy rash at any time in the past 12 months?’ and ‘Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or around the neck, ears or eyes?’ question preceded by:Have you/has your child ever had an itchy rash coming and going for at least 6 months?
Core questionnaires – eczema
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Current symptoms of eczema: ‘Have you (has your child) had this itchy rash at any time in the past 12 months?’ and ‘Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or around the neck, ears or eyes?’ question preceded by:Have you/has your child ever had an itchy rash coming and going for at least 6 months?
Severe symptoms of eczema:Defined as participants who, in the past 12 months, had sleep disturbance one or more times per week
Core questionnaires – eczema
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DIET
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Current symptoms of eczema: ‘Have you (has your child) had this itchy rash at any time in the past 12 months?’ and ‘Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or around the neck, ears or eyes?’ question preceded by:Have you/has your child ever had an itchy rash coming and going for at least 6 months?
Severe symptoms of eczema: Defined as participants who in the past 12 months had sleep disturbance one or more times per week.
Core questionnaires – eczema
![Page 52: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/52.jpg)
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The environmental questionnaire diet questions
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Respondents were asked: ‘In the past 12 months how often, on average, did you (did your child) eat or drink the following food groups:
The environmental questionnaire diet questions
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Respondents were asked: ‘In the past 12 months how often, on average, did you (did your child) eat or drink the following food groups:
Meat, seafood, fruit, vegetables (green and root), pulses
(peas, beans, lentils), cereal (including bread), pasta,
rice, butter, margarine, nuts, potatoes, milk, eggs and
fast food/burgers.
The environmental questionnaire diet questions
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The environmental questionnaire food intake categories
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The three categories for food intake were:
The environmental questionnaire food intake categories
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The three categories for food intake were:
Never or occasionally
The environmental questionnaire food intake categories
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The three categories for food intake were:
Never or occasionally
Once or twice per week
The environmental questionnaire food intake categories
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The three categories for food intake were:
Never or occasionally
Once or twice per week
And ≥ 3 times per week
The environmental questionnaire food intake categories
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Analyses
Prevalence odd ratios (ORs) were calculatedfrom the individual level data using generalised linear mixed models with a binomial distribution and logit link,With the centres modelled as a random effect
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The Univariate analyses adjusted for:
Analyses
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Univariate analyses adjusted for:
• Gender
Analyses
![Page 65: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/65.jpg)
Univariate analyses adjusted for:
• Gender • Region of the world
Analyses
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Univariate analyses adjusted for:
• Gender • Region of the world• Language
Analyses
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Univariate analyses adjusted for:
• Gender • Region of the world• Language• Per capita gross national income (world bank categories)
Analyses
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The Univariate analyses adjusted for:
• Gender • Region of the world• Language• Per capita gross national income (world bank categories)
Further multiple regression analyses adjusted for
Analyses
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Univariate analyses adjusted for:
• Gender • Region of the world• Language• Per capita gross national income (world bank categories)
Further multiple regression analyses adjusted for
Analyses
• Exercise
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Univariate analyses adjusted for:
• Gender • Region of the world• Language• Per capita gross national income (world bank categories)
Further multiple regression analyses adjusted for
Analyses
• Exercise • Television watching
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Univariate analyses adjusted for:
• Gender • Region of the world• Language• Per capita gross national income (world bank categories)
Further multiple regression analyses adjusted for
Analyses
• Exercise • Television watching • Maternal education
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Univariate analyses adjusted for:
• Gender • Region of the world• Language• Per capita gross national income (world bank categories)
Further multiple regression analyses adjusted for
Analyses
• Exercise • Television watching • Maternal education • Maternal smoking (first year of life and current)
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Univariate analyses adjusted for:
• Gender • Region of the world• Language• Per capita gross national income (world bank categories)
Further multiple regression analyses adjusted for
Analyses
• Exercise • Television watching • Maternal education • Maternal smoking (first year of life and current)• Body Mass Index (showed no effect)
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Number of participants:
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The diet analysis involved:
Number of participants:
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The diet analysis involved:
319 196 adolescents from 107 centres in 51 countries
Number of participants:
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The diet analysis involved:
319 196 adolescents from 107 centres in 51 countries
181 631 children from 64 centres in 31 countries
Number of participants:
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Results
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The Adolescent age group (13-14 years)
Results
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The Adolescent age group (13-14 years)
Protective foodsAll centres combined. Intake once or twice per week and ≥ 3 times per week for current & severe wheeze
Results
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The Adolescent age group (13-14 years)
Protective foodsAll centres combined. Intake once or twice per week and ≥ 3 times per week for current & severe wheeze
Fruit (and for current rhinoconjunctivitis)
Results
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The Adolescent age group (13-14 years)
Protective foodsAll centres combined. Intake once or twice per week and ≥ 3 times per week for current & severe wheeze
Fruit (and for current rhinoconjunctivitis)
Milk (≥ 3 times per week severe asthma, current eczema)
Results
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The Adolescent age group (13-14 years)
Protective foodsAll centres combined. Intake once or twice per week and ≥ 3 times per week for current & severe wheeze
Fruit (and for current rhinoconjunctivitis)
Milk (≥ 3 times per week severe asthma, current eczema)
Vegetables (≥ 3 times per week current asthma only)
Results
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The Adolescent age group (13-14 years)
Results
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The Adolescent age group (13-14 years)
Risk factor foodsAll centres combined intake ≥ 3 times per week for all three conditions
Results
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The Adolescent age group (13-14 years)
Risk factor foodsAll centres combined intake ≥ 3 times per week for all three conditions
Fast food (strongest association)
Results
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The Adolescent age group (13-14 years)
Risk factor foodsAll centres combined intake ≥ 3 times per week for all three conditions
Fast food (strongest association)
Margarine, nuts, butter, pasta
Results
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The Adolescent age group (13-14 years)
Risk factor foodsAll centres combined intake ≥ 3 times per week for all three conditions
Fast food (strongest association)
Margarine, nuts, butter, pasta
Eggs (≥ 3 times per week for severe asthma & severe rhinoconjunctivitis
Results
![Page 89: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/89.jpg)
The childrens age group (6-7 years)
Results
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The childrens age group (6-7 years)
Protective foodsAll centres combined. Intake ≥ 3 times per week for all three conditions (severe)
Results
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The childrens’ age group (6-7 years)
Protective foodsAll centres combined. Intake ≥ 3 times per week for all three conditions (severe)
Eggs, fruit, meat, Milk
Results
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The childrens’ age group (6-7 years)
Protective foodsAll centres combined. Intake ≥ 3 times per week for all three conditions (severe)
Eggs, fruit, meat, Milk
Seafood (current and severe asthma only)
Results
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The childrens’ age group (6-7 years)
Protective foodsAll centres combined. Intake ≥ 3 times per week for all three conditions (severe)
Eggs, fruit, meat, Milk
Seafood (current and severe asthma only)
Vegetables (except for severe eczema)
Results
![Page 94: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/94.jpg)
The childrens age group (6-7 years)
Results
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The childrens age group (6-7 years)
Risk factor foodsAll centres combined. Intake ≥ 3 times per week for current & severe wheeze, current and severe rhinoconjunctivitis and severe eczema
Results
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The childrens age group (6-7 years)
Risk factor foodsAll centres combined. Intake ≥ 3 times per week for current & severe wheeze, current and severe rhinoconjunctivitis and severe eczema
Fast food
Results
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The childrens age group (6-7 years)
Risk factor foodsAll centres combined. Intake ≥ 3 times per week for current & severe wheeze, current and severe rhinoconjunctivitis and severe eczema
Fast food
Margarine (current rhinoconjunctivitis only)
Results
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Current wheeze and frequent consumption of fast food, 6-7 year age group
Ellwood P et al. Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Thorax 2013; 68(4):351-360.
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Severe asthma and frequent consumption of fast food, 6-7 year age group
Ellwood P et al. Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Thorax 2013; 68(4):351-360.
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Discussion
Potential Implications
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Discussion
Potential Implications
Findings are consistent with two previous analyses which found positive associations between fast food consumption and prevalence of wheeze
Wickens K, et al. Fast foods - are they a risk factor for asthma?. Allergy 2005; 60(12): 1537-41
.Robertson CF. The association between fast food outlets and the prevalence of symptoms of asthma from the International Study of Asthma and Allergies in Childhood (ISAAC)[Abstract]. Eur Resp J 1998; 12: Suppl 28.
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Discussion
Potential Implications
Findings are consistent with two previous analyses which found positive associations between fast food consumption and prevalence of wheeze
Biologically plausible mechanisms could be related to higher saturated fatty acids, trans fatty acids, sodium, carbohydrates and sugar levels of fast food and of preservatives
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Conclusions
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Conclusions
• Fast food was the only food type to show the same associations across the two age groups and all regions
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Conclusions
• Fast food was the only food type to show the same associations across the two age groups and all regions
• Fast food consumption may be contributing to the increasing prevalence of asthma, rhinoconjunctivitis and eczema in adolescents and children although the mechanism is unclear
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Conclusions
• Fast food was the only food type to show the same associations across the two age groups and all regions
• Fast food consumption may be contributing to the increasing prevalence of asthma, rhinoconjunctivitis and eczema in adolescents and children although the mechanism is unclear
• Diets that have a regular consumption of fruit and vegetables are likely to protect against asthma, rhinoconjunctivitis and eczema in adolescents and children
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Conclusions
• For other foods, the picture for adolescents and children is less clear
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Conclusions
• For other foods, the picture for adolescents and children is less clear
• Further work is required in this area
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Conclusions
• For other foods, the picture for adolescents and children is less clear
• Further work is required in this area
• The Global Asthma Network has been established to continue the work of ISAAC (formed by some former members of ISAAC and from The International Union against Tuberculosis and Lung Disease [The Union])
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http://www.globalasthmanetwork.org
Established 2012
© GAN
![Page 112: Do fast foods cause asthma, rhinoconjunctivitis and eczema? Philippa Ellwood Senior Research Fellow Department of Paediatrics: Child and Youth Health,](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649dd95503460f94ace2e7/html5/thumbnails/112.jpg)
Global Asthma Network 204 centres in 92 countries
http://www.globalasthmanetwork.org/
© GAN